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“Today, Intermountain at Home’s hospital-level care in patient’s homes can help support the health system in the event of a surge of COVID-19 patients.”

Before COVID-19, Intermountain Healthcare located in Salt Lake City, UT had expanded its home-based services to include primary care, some traditional hospital-level services, and palliative care for patients with chronic or serious medical conditions.

The service, called Intermountain at Home, is a comprehensive program that expanded established Intermountain Homecare & Hospice services to prevent or shorten hospital admissions and enable patients to receive care where they prefer to receive it in their homes.

Today, Intermountain at Home’s hospital-level care in patient’s homes can help support the health system in the event of a surge of COVID-19 patients.

“This innovative program is designed around people, supporting first and foremost our patients who are at risk for hospitalization or complications, along with their families,” said Rajesh Shrestha, Intermountain chief operating officer of community-based care. “It will help us keep our patients comfortable and at home, continually connected with caregivers who will monitor their health status through Intermountain’s advanced clinical information systems when we’re not with them.”

Background

Home-based nursing services were introduced at Intermountain in 1982 to transition patients safely home after hospital discharges. Since then, Intermountain Homecare & Hospice has continued to grow and now supports patients with home-based post-hospital, palliative, and end-of-life care as well as medical equipment maintenance.

Intermountain at Home incorporated these services and added other functions including ongoing home check-ups with a primary care physician or advanced practice clinician. These providers address their patients’ medical needs and symptoms of chronic or serious medical conditions, without requiring patients to travel to a hospital or clinic.

The home-based, hospital-level services include:

  • remote monitoring
  • expanded telemedicine capabilities
  • virtual urgent care visits through Intermountain Connect Care,  a 24/7 online service that allows patients to receive personalized care from Intermountain caregivers via their smartphones, tablets, and computers
  • appointment-based video visits
  • home caregiver and family support tools
  • dialysis and intravenous medication
  • physical therapy

Also, this model includes daily living support through Homespire, an Intermountain company that helps seniors and other people live healthy and independent lives at home.

This support focuses on the social determinants of health, or factors in the places where people live, learn, work, and play that can impact their well-being and quality of life, including finances, education, physical environment, social support, coping skills, healthy behaviors, and access to health services.

Hospital at Home Model Partnership

Intermountain has a strong legacy of providing care in people’s homes through Intermountain Homecare and a robust telehealth team with experience in providing care via digital platforms.

The in-home hospital-level care is in partnership with Castell, a comprehensive health platform company that helps organizations transition to value-based care, improve patient outcomes, and keep costs more affordable. Castell is an Intermountain Healthcare company.

“The hospitals of the future will expand virtually into homes to provide appropriate acute-level care. This new service supports patients who are at risk for hospitalization or complications, along with their families,” said Rajesh Shrestha, Castell president and CEO and Intermountain VP and COO for community-based care.

“Many patients find they feel more calm and comfortable at home than in a hospital, and that in itself can be conducive to healing. It also allows people to be more independent,” he added.

At Intermountain, healthcare providers will identify patients who need hospitalization but could benefit and qualify for receiving certain hospital-level care services at home. They will offer home hospital-level care as an option for patients who would like to participate and with an insurance plan or payment currently in a value-based arrangement with Intermountain.

The service will treat patients for conditions such as congestive heart failure, some kidney-related conditions, some intestinal or vein conditions, infections such as cellulitis, and certain cancer diagnoses.

Providing hospital-level services in patient homes helps reduce unnecessary trips to the emergency room, and shorten or eliminate the time some patients spend in a hospital setting while allowing them to continue to receive the acute care they need.

“When caregivers are able to actually see and treat a patient in their home environment, they gain a better understanding of ways to help the patient make their daily tasks safer, healthier, or easier,” said Josh Romney, MD, Castell population health medical director and an internal medicine physician with Intermountain Medical Group.

“Receiving hospital-level care at home typically costs less than overnight hospital stays, which ultimately leads to lower out of pocket costs – not only for patients – but health systems as well,” said Nick Bassett, Castell vice president of population health services.

“If I’d had this home monitoring years ago, it would have saved me many trips to the emergency room,” said Rickey Florez, a congestive heart failure patient currently receiving hospital-level services at home. Florez had a heart attack in 2012 followed by multiple bypass heart surgery on Valentine’s Day that year.

“With home monitoring, I’m more aware of my body and better understand the numbers the doctors are looking at and what they mean. Receiving care at home is very helpful because I don’t drive anymore and my kids work, so transportation is hard,” added Florez.

How It Works

Details of this new service include initial set-up and orientation in the hospital, followed by regular in-person and virtual check-ins from a care team of in-home and tele-nurses, as well as a tele-hospitalist. On-call services are available 24 hours a day, seven days per week.

Patients are provided with a remote patient monitoring kit and other home health equipment as needed for their particular diagnoses. Standard equipment includes a blood pressure monitor, pulse oximeter, cellular-enabled digital tablet, and a digital scale. Additional equipment such as a continuous heart rate and oxygen sensor will be added, based on a patient’s diagnosis. All the devices connect to the tablet through Bluetooth and transmit vital signs to a remote monitoring center where a team of Intermountain Telehealth specialists monitor patients 24/7.

“Enabling hospital-level care in patients’ homes will help advance Intermountain Healthcare’s transition to value-based care, where the goal is to keep patients healthy, improve outcomes and reduce overall costs,” Dr. Romney added.

About Intermountain Healthcare

Intermountain Healthcare is a not-for-profit system of 24 hospitals, 215 clinics, a Medical Group with 2,500 employed physicians and advanced practice clinicians, a health insurance company called SelectHealth, and other health services in Idaho, Utah, and Nevada. Intermountain is widely recognized as a leader in transforming healthcare by using evidence-based best practices to consistently deliver high-quality outcomes and sustainable costs.

Castell

Castell is a comprehensive health platform company that makes the move to value-based care simple for providers, payers, health systems, and accountable care organizations. Castell delivers impactful analytic and service solutions designed to accelerate organizations’ transition from volume to value, improve outcomes, and keep costs more affordable. Castell is an Intermountain Healthcare company.

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